Scrotal Mass Research Articles

English

Infantile fibromatosis is a process that is difficult to differentiate from fibrosarcoma. It is common in neonates and infants and usually arises from head and neck. Only rarely it has been reported to involve the external genitalia or scrotum. We report a case of an eight-month old infant who presented with a painless scrotal mass that has been slowly enlarging for the previous 3- months. Gray-scale sonography demonstrated a heterogeneously echogenic paratesticular mass in right hemiscrotum. Histologic examination of the excised mass revealed infantile fibromatosis of the scrotum. Sonographic appearance of this entity has not been described previously.

Triorchidism: two case reports

In this study, two cases of triorchidism are reported. The first case (29years) had two right discrete ovoid nontender, firm, mobile lumps with testicular sensation. The second case (32years) had two left discrete ovoid nontender, firm, mobile lumps with normal testicular sensation. They were subjected to the estimation of serum follicle-stimulating hormone, luteinising hormone, free and total testosterone, alpha-fetoprotein, prostate-specific antigen, karyotyping and semen analysis. Imaging included ultrasonography, transrectal ultrasound, magnetic resonance imaging and intravenous pyelography. The first case had two testes in the right side. Each one had an epididymis where one vas deferens was palpated. The second case had two left testes with normal testicular sensation. The lower left lump represented normal-sized testis attached to its epididymis and a single palpated vas deferens. Diagnosis of the first case was triorchidism associated with left varicocele (grade I) with oligoasthenoteratozoospermic semen profile. Intracytoplasmic sperm injection was carried out resulting in a twin. Diagnosis of the second case was triorchidism with accessory testis on the left side associated with left varicocele (grade I) and asthenozoospermic semen profile that was submitted to medical treatment. It is concluded that triorchidism is an uncommon congenital anomaly that should be not overlooked in diagnosing scrotal masses.

Splenogonadal Fusion: A Rare Etiology of Solid Testicular Mass

A 35-year-old man presented with a painless left scrotal mass. Pathologic examination after orchiectomy revealed splenogonadal fusion. Splenogonadal fusion is an exceptionally rare, typically benign, congenital anomaly. Splenogonadal fusion should be included in the differential diagnosis of a left-sided testicular mass.

Index of Suspicion in the Nursery

A 3.7-kg, 6-day-old term infant presents to the emergency department with decreased oral intake, irritability, and respiratory distress. No history of fever, or respiratory or gastrointestinal symptoms are elicited. Prenatal and delivery history are unremarkable, including negative maternal serologies and Group B streptococcus testing. Mother is healthy, but the sibling has rhinorrhea and cough. The infant is intubated for respiratory distress, receives 60 mL/kg of normal saline boluses for poor perfusion, and dopamine is started for hypotension. The infant is noted to have a blanching, maculopapular erythematous rash involving the axilla and trunk, but otherwise has a nonfocal physical examination. A sepsis evaluation is performed, including blood, urine, and cerebrospinal fluid (CSF) cultures. Empirical antimicrobial therapy with ampicillin, gentamicin, and acyclovir is administered, and the infant is transferred to the NICU for further management. A 6-week-old healthy boy presents with bilateral painless scrotal swelling. He was born at term via normal vaginal delivery following an uneventful pregnancy; antenatal ultrasound scans were normal. The scrotal mass had been present since birth and initially was believed to be a hydrocele but it had become firmer over a course of 6 weeks. On physical examination, it consisted of two small, grape-size swellings, one above the left testis and one below the right testis. There was no history of delayed passage of meconium or any sign of bowel obstruction. Plain abdominal radiograph was performed and did not show intra-abdominal calcifications. An ultrasound scan demonstrated that both testes were normal in size, shape, and echodensity. Within the right and left scrotum there were paratesticular masses of mixed echogenicity. Both masses could be traced toward the inguinal canal, as shown in Fig 1. There were no abdominal calcifications. Sweat test and tissue culture were performed to exclude cystic fibrosis and tuberculosis, respectively, and were negative. …

Pictorial review: paediatric groin and scrotal lumps and bumps

This pictorial review explores the wide spectrum of paediatric groin and scrotal masses. Examples overlap with the adult population but concentrate on those more common in, or unique to, children. Correlation with other imaging modalities is included where appropriate.

Inflammatory pseudotumor of the epididymis: a case report and review of the literature.

Inflammatory pseudotumors (IPTs) are rare benign tumor-like lesions in the epididymis. They result from myofibrohistiocytic proliferation of the parenchymal organs of the body, such as the lungs and genitourinary system. A 48-year-old male patient presented with a palpable left scrotal mass and developed painless swelling within two months. Scrotal ultrasound revealed a 3 cm solid mass and spermatocele sac in the epididymis. Local excision was performed. Histopathologic and immunohistochemical examination revealed an inflammatory pseudotumor. Only ten cases have been reported in the literature to date. We present our case of pseudotumor of the epididymis as the eleventh case reported in the literature with a brief review.

Management of epididymal cysts in childhood

BackgroundA retrospective review was carried out to evaluate the clinical presentation of children with epididymal cysts (EC) and outcome of management at our institution. MethodsThere were 49 patients with EC in this series. The diagnosis of EC was made by physical examination and confirmed by ultrasound (US). ResultsThe average age at presentation was 10.7years (2months–16years). Scrotal mass (n: 22) and pain (n: 21) were the most frequent symptoms. Seven patients were lost to follow-up. The cysts were solitary in 32 patients and multiple in 10 patients. The mean value of cysts was 6.7mm (2–20mm). The cyst localisations were 22 in left, 16 in right, and bilateral in 4 patients. Complete involution of cysts was detected in 14 children. The average involution time was 11.2months (1–37months). In 20 cases, a decrease in cyst size was found. Cyst excision was performed in 8 patients with persistent scrotal pain or no cyst involution observed during follow-up. ConclusionConservative management of epididymal cysts is practical. However, surgical excision is recommended in patients with intractable scrotal pain or if the cyst size does not seem to involute.

Bilateral Polyorchidism With Diffuse Microlithiasis: A Case Report of an Adolescent With 4 Testes

Polyorchidism is a rare congenital anomaly, with only 140 pathologically proven cases reported. Bilateral polyorchidism is far less common than triorchidism. Most cases present as a painless scrotal mass or are found incidentally during evaluation of other inguinoscrotal pathologies. We report a case of bilateral polyorchidism with 4 testes, 2 in each hemiscrotum that presented as left-sided testicular pain and hydrocele.

Paratesticular fibrous pseudotumor in young males presenting with histological features of IgG4-related disease: two case reports

IntroductionParatesticular fibrous pseudotumors represent benign new growths confined to intrascrotal structures. Both pathogenesis and clinical management are little understood due to the rarity of the lesion, with less than 200 cases reported to date. Recently, paratesticular fibrous pseudotumors have been postulated to be immunoglobulin G4-related, pathogenetically. Here we report two cases of patients with paratesticular fibrous pseudotumor to highlight the clinical features of this rare disease and we report the immunohistochemical examinations to support the theory of paratesticular fibrous pseudotumor being an immunoglobulin G4-related disease.Case presentationsA 28-year-old white man presented with a painless intrascrotal mass. After a clinical examination, a malignant growth was suspected. His ultrasound results revealed a well-demarcated hypoechoic lesion of 1.5cm in diameter at the spermatic cord. Our patient underwent local excision. His follow-up has been uneventful for 12 years. The second case was an 18-year-old white man who presented with a painless scrotal mass suspicious of testicular tumor. A magnetic resonance imaging scan revealed a 3cm mass at the spermatic cord with very low signal density on T2-weighted imaging and a low and inhomogeneous uptake of gadolinium contrast agent on T1-weighted, fat-suppressed imaging. Following local excision, our patient has been well for 18 months.On histological examination, both of the lesions consisted of collagen-rich hyalinized fibrotic tissue with storiform features. There were lymphofollicular infiltrates and, sporadically, also venulitis. The immunoglobulin G4 staining (in case 2) showed an infiltrate of 10 to 15 positive cells per high-power field on average, corresponding to a proportion of 40% in evaluable hot spots. The two patients with paratesticular fibrous pseudotumor presented within a time span of 15 years. During that time, 400 patients with testicular germ cell tumors had been treated in our institution.ConclusionsThe specific histological features documented in our case lend support to the theory of paratesticular fibrous pseudotumor being an immunoglobulin G4-related sclerosing disorder. Paratesticular fibrous pseudotumors usually occur in young adulthood. Clinically, paratesticular fibrous pseudotumor can mimic testicular malignancy. Ultrasonographic findings are largely unspecific, however, scrotal magnetic resonance imaging may aid in discriminating the lesion from malignant tumors. Local excision, whenever technically feasible, is the preferred treatment of paratesticular fibrous pseudotumor.

Testicular Torsion in the First Year of Life – Characteristics and Treatment Outcome

To review the characteristics and treatment outcome of testicular torsion in infants, aged 1 month to 1 year, and compare them with those seen in neonates. The study group included 30 patients aged younger than 1 year who were treated for testicular torsion at a tertiary pediatric medical center between 1993 and 2012. Medical records were retrospectively reviewed for clinical characteristics and treatment outcome. Findings were compared between patients who presented before age 1 month (neonate group, n = 17) or later (infant group, n = 13). The common clinical presentation in the neonate group was a solid, nontender scrotal mass apparent in 13 of 17 patients (76%). In the infant group, 11 of 13 patients (85%) presented with restlessness and 12 of 13 (92%) with a tender scrotal or inguinal mass. Torsion of an undescended testis was significantly more prevalent in infants, 7 of 13 (54%), than neonates, 1 of 17 (6%; P = .009). Although extravaginal torsion was documented in 5 of 6 neonates (83%), 8 of 9 infants (89%) had an intravaginal torsion (P = .011). Orchiectomy was performed in 14 of 17 neonates (82%) and 6 of 13 infants (46%; P = .056). Of the 29 patients with follow-up data, testicular salvage was documented in 1 of 17 neonates (6%) and 2 of 12 infants (17%), at a minimum follow-up of 5 months (P = .55). Testicular torsion in the first year of life is a diverse condition. Although neonatal torsions were predominantly extravaginal, infantile torsions were mostly intravaginal, involving undescendent testes in more than half of the cases. Despite fewer orchiectomies performed on the infant group, testicular salvage rates in both groups were similarly low.

Lararoscopic Retroperitoneal Lymph Node Dissection for Paratesticular Rhabdomyosarcoma in Older Children/Adolescents

Testicular tumors are far more common in adults than in children. For this reason, management of pediatric testis tumors has been based on experience in adults. However, there are important differences between testis tumors occurring in children and those occurring in adults. These differences involve tumor histopathology, malignant potential, and pattern of metastatic spread [1]. The majority of primary testis tumors in the Prepubertal Testis Tumor Registry of the Urologic Section of the American Academy of Pediatrics were yolk sac tumors, followed by teratomas and stromal tumors. Because teratomas and most stromal tumors are benign in children, it would follow that fewer than two thirds of prepubertal testis tumors have malignant potential, compared with 90 % of tumors in adults. It is even possible that the majority of prepubertal tumors are benign. Several single-center studies suggest that teratomas are more common than yolk sac tumors in pediatric patients; however, these studies were not limited to prepubertal patients [2–5] . Paratesticular rhabdomyosarcomas usually present with an enlarging painless scrotal mass. By the time they present it is usually not possible to distinguish from a primary testis tumor on physical examination, though the extra-testicular nature of the tumor is usually apparent on ultrasound. Trans-scrotal biopsies of solid scrotal masses should be avoided due to the risk of seeding of the incision if the mass is indeed a rhabdomyosarcoma. The excision of the tumor should be performed just as for a testicular malignancy. The metastatic evaluation for paratesticular rhabdomyosarcoma includes a CT (Computed tomography) of the chest, abdomen, and pelvis. A majority of patients will have clinical stage 1 disease. The most common sites of metastases are the retroperitoneum and lungs. Patients with retroperitoneal metastases should undergo a modified unilateral nerve-sparing RPLND (Retroperitoneal lymph node dissection). All patients should receive chemotherapy and those with positive retroperitoneal nodes should receive radiation therapy as well [1]. We report on two older children/adolescents who underwent Laparoscopic-RPLND.

Paratesticular dedifferentiated liposarcoma with leiomyosarcomatous differentiation: a case report with a review of literature

Paratesticular liposarcoma is a rare neoplasm, described in single case studies or components of larger studies, as histologically well-differentiated liposarcoma (WDL) and dedifferentiated liposarcoma (DL). However, leiomyosarcomatous differentiation is an extremely rare occurrence in WDL and DL. We report a case of leiomyosarcomatous differentiation in a 77-year-old man. The patient presented with a painless right scrotal mass. Magnetic resonance imaging showed a large mass along the right spermatic cord. The resected mass, measuring 17.5 × 12 × 5 cm, was composed of a high-grade pleomorphic undifferentiated sarcomatous component with necrosis. Atypical smooth muscle differentiation was also detected. Additional tumor sampling revealed the presence of a WDL component. Immunohistochemical analysis of the pleomorphic sarcomatous component showed positive staining for MDM2 and CDK4, and negative staining for alpha smooth muscle actin (αSMA) and desmin. The smooth muscle component was positive for αSMA and desmin, and negative for MDM2 and CDK4. Extension from primary retroperitoneal sarcoma was not proved. We diagnosed of DL with leiomyosarcomatous differentiation.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1484291498104021.

Report of a boy with polyorchidism and a review of current knowledge regarding this unusual anomaly.

Polyorchidism is an extremely rare testicular malformation in children, and its etiology is unknown. There is an increased risk for testicular malignancy in these patients and a common association with other abnormalities, such as cryptorchidism, inguinal hernia, testicular torsion, hydrocele, and varicocele. There are insufficient data in the literature on the ideal management of polyorchidism. We report a 14-year-old boy with polyorchidism and review the current literature regarding this anomaly. Physical examination revealed a discrete, painless, left intrascrotal lump. αFP, β-hCG and LDH were normal. Scrotal ultrasound showed a well-circumscribed tissue in the left hemiscrotum measuring 2.5×2.0×1.3 cm and having the same echo-genicity as the normal testes. Color Doppler study and magnetic resonance imaging also confirmed the tissue as a third testis with its own epididymis draining to a common vas. The testis was left in situ, and the patient was managed conservatively. Polyorchidism should be considered in the differential diagnosis of all scrotal masses. The etiology of polyorchidism is thought to be accidental division of the genital ridge before 8 weeks of gestation. The cases are divided into two categories according to anatomical properties, such as having drainage to an epididymis and vas deferens. The majority of cases are mainly encountered during evaluation for the other symptoms associated. Recent evidence supports that these cases may be followed conservatively when clinical findings and imaging techniques detect no complications or suspicion for malignancy, torsion, hernia, or cryptorchidism.

Solid Testicular Mass in a 44-Year-Old Man

Figure 1. Ultrasound image of the left testicle showed a heterogenously low echogenic tumor within the left testis and normal left epididymis. Ahad noticed 6 months earlier. He reported left scrotal pain for a week before the visit but denied scrotal trauma or frank pain. He also denied voiding symptoms, gross hematuria, penile discharge, fever, or weight loss. His urologic history was insignificant, and his medical and surgical histories were significant only for hypertension. He also denied smoking. On physical examination, the patient had a firm, round, motile left scrotal mass with mild tenderness. Complete blood cell count and serum biochemistry tests revealed no significant abnormality. Serum lactic dehydrogenase (185 IU/L [normal reference range, 124-226 IU/L]), a-fetoprotein (6.9 ng/mL [normal reference value, <15 ng/mL]), b-subunit of human chorionic gonadotropin (<0.1 ng/mL [normal reference value, <0.2 ng/mL]), and C-reactive protein (0 mg/dL [normal reference value, <0.2 mg/dL]) were not elevated. A tuberculin skin reaction was slightly positive, suggesting no active tuberculosis infection. Ultrasound imaging revealed a heterogeneously hypoechoic and hypovascular lesion 3 cm in diameter within the left testis (Fig. 1), with apparently intact epididymis separated from the tumor. Multiple cystic lesions were also observed to the left side of the prostate. The left kidney was not visualized. A computed tomography (CT) scan also showed a solid, weakly enhanced mass in the left scrotum, and multiple cystic masses on the left seminal vesicle, a highly hypoplastic left kidney, and no retroperitoneal lymphadenopathy (Fig. 2).

A rare case: paratesticular leiomyosarcoma

A rare case: paratesticular leiomyosarcoma

US in the assessment of acute scrotum

BackgroundThe acute scrotum is a medical emergency . The acute scrotum is defined as scrotal pain, swelling, and redness of acute onset. Scrotal abnormalities can be divided into three groups , which are extra-testicular lesion, intra-testicular lesion and trauma. This is a retrospective analysis of 164 ultrasound examination performed in patient arriving in the emergency room for scrotal pain.The objective of this article is to familiarize the reader with the US features of the most common and some of the least common scrotal lesions.MethodsBetween January 2008 and January 2010, 164 patients aged few month and older with scrotal symptoms, who underwent scrotal ultrasonography (US), were retrospectively reviewed. The clinical presentation, outcome, and US results were analyzed. The presentation symptoms including scrotal pain, painless scrotal mass or swelling, and trauma.ResultsOf 164 patients, 125 (76%) presented with scrotal pain, 31 (19%) had painless scrotal mass or swelling and 8 (5%) had trauma. Of the 125 patients with scrotal pain, 72 had infection,10 had testicular torsion, 8 had testicular trauma, 18 had varicocele, 20 had hydrocele, 5 had cryptorchidism, 5 had scrotal sac and groin metastases, and 2 had unremarkable results. In the 8 patients who had history of scrotal trauma, US detected testicular rupture in 1 patients, scrotal haematomas in 2 patients .Of the 19 patients who presented with painless scrotal mass or swelling, 1 6 had extra-testicular lesions and 3 had intra-testicular lesions. All the extra-testicular lesions were benign. Of the 3 intra-testicular lesions, one was due to tuberculosis epididymo-orchitis, one was non-Hodgkin’s lymphoma, and one was metastasis from liposarcomaConclusionsUS provides excellent anatomic detail; when color Doppler and Power Doppler imaging are added, testicular perfusion can be assessed

Epididymal lymphoma: report of two cases and imaging findings

Epididymal lymphoma is a very rare tumor that is difficult to differentiate radiologically from other paratesticular tumors. Most cases of epididymal lymphoma are secondary involvement of the epididymis in patients with testicular lymphoma. However, isolated epididymal lymphoma is very rare. We herein report two cases of isolated epididymal lymphoma with different imaging findings. Patient 1 was a 52-year-old man who presented with a painless scrotal mass. Patient 2 was a 65-year-old man who presented with painless scrotal swelling. Ultrasound (US) demonstrated different imaging findings: US in patient 1 showed a well-defined round mass in the tail of the epididymis with hypervascularity confined to the epididymis, while US in patient 2 showed diffuse infiltrative enlargement with hypervascularity confined to the epididymis. Orchiectomy performed in both patients revealed diffuse large B-cell lymphoma confined to the epididymis.

Spermatocytic seminoma in a 92-year-old man: report of a case in which SALL4, a potential novel marker for testicular germ cell tumors, was useful for the diagnosis

Spermatocytic seminoma (SS) is a rare testicular germ cell tumor (TGCT), occurring exclusively in the testes. Diagnosis of SS is important because, unlike other testicular tumors, SS must be treated by orchiectomy alone without further adjuvant therapy owing to its inability to metastasize. However, an accurate diagnosis of SS is often difficult given its rarity and the lack of a reliable marker. We report the occurrence of SS in a 92-year-old man—one of the oldest SS patients reported thus far. The patient presented with a painful right scrotal mass, which had been present for 6 months. A computed tomography scan revealed a testicular mass. There was no significant increase in the serum levels of alpha-fetoprotein (AFP) or human chorionic gonadotropin (hCG). A right orchiectomy was performed, which showed a well-circumscribed white-gray mass. A histological examination revealed sheets of non-cohesive cells with little intervening stroma. The tumor consisted of small, medium, and large cells with frequent mitoses, which is suggestive of SS. Whereas common TGCT markers including AFP, hCG, CD30, and placental alkaline phosphatase were all negative, nuclear reactivity for SALL4, a new TGCT marker, and positivity for CD117 (c-kit) finally helped establish the diagnosis of SS. We conclude that SALL4 immunostaining can be helpful for the diagnosis of TGCT when tumors are negative for conventional TGCT markers.

Meconium periorchitis: A case report and literature review

Meconium periorchitis (MPO) is an uncommon entity associated with healed meconium peritonitis. The typical presentation is a soft hydrocele at birth which becomes harder in weeks as the meconium calcifies. A lack of awareness of this rare disease may lead to unnecessary surgery of scrotal masses. It can resolve spontaneously without compromising the testicle. Scrotal ultrasound is the mainstay of imaging and abdominal plain film is less sensitive but can help in the diagnosis. We report a case of a meconium periorchitis and discuss its radiological and histological features. We also review the relevant literature.

Abdominal neuroblastoma presenting as metastatic scrotal masses: a case report and review of the literature

Neuroblastoma (NB) is one of the most common solid cancers of early childhood, and it remains a vital clinical problem, with a 15 % mortality rate in children. In this report, we describe the case of a 5-month-old infant with scrotal masses, left hydrocele, and right undescended testes (UDT). A 5-month-old boy was referred to our center with bilateral scrotal masses as a first presentation and midline retroperitoneal mass. Unfavorable histopathologic examination confirmed the diagnosis of NB. Left orchiopexy and herniotomy were performed with complete resection of paratesticular tumor. The patient received the standard chemotherapy regimen and no tumor was detected within 3 years of follow-up. Testicular and paratesticular organs are rarely reported sites for NB. The testicular area should be considered as one of the key points in cancer examination due to being a small and under-observed region for tumor enlargement. Additionally, biochemical analysis and ultrasound can play a crucial role in investigation of painless masses.